Department of Orthopaedic Surgery, Ain Shams University, Cairo, Egypt.
Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Birmingham, UK.
Cochrane Database Syst Rev. 2023 Aug 16;8(8):CD013570. doi: 10.1002/14651858.CD013570.pub2.
Donor site wounds of split-thickness skin grafts can be a major cause of morbidity. Choosing the appropriate dressing for these wounds is crucial to successful healing. Various types of dressing are available, including hydrogel dressings. A review of current evidence is required to guide clinical decision-making on the choice of dressing for the treatment of donor sites of split-thickness skin grafts.
To assess the effects of hydrogel dressings on donor site wounds following split-thickness skin grafts for wound healing.
In July 2022 we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL EBSCO Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses, and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication, or study setting.
Randomised controlled trials (RCTs) comparing hydrogel dressings with other types of dressing, topical treatments or no dressing, or with different types of hydrogel dressings in managing donor site wounds irrespective of language and publication status.
Two review authors independently carried out data extraction, risk of bias assessment using the Cochrane risk of bias tool, RoB 1, and quality assessment according to GRADE methodology.
We included two studies (162 participants) in this review. One study with three arms and 101 participants (15 months' duration) was conducted in a children's hospital, and compared hydrogel dressings in the form of Sorbact with Algisite, an alginate dressing and Cuticerin, a smooth acetate gauze impregnated with water-repellent ointment. Another study with two arms and 61 participants (19 months' duration) was conducted in three surgery departments and compared an octenidine-containing hydrogel dressing with an identical non-antimicrobial hydrogel dressing. We identified no studies that compared hydrogel dressings with another therapy such as a topical agent (a topical agent is a cream, an ointment or a solution that is applied directly to the wound), or no dressing, or a combination of hydrogel dressings and another therapy versus another therapy alone. Both studies were at high risk of attrition bias and the second study was also at unclear risk of selection bias. Amorphous hydrogel dressings versus other types of dressings Amorphous hydrogel dressings may increase time to wound healing when compared with alginate (mean difference (MD) 1.67 days, 95% confidence interval (CI) 0.56 to 2.78; 1 study, 69 participants; low-certainty evidence) or Cuticerin dressings (MD 1.67 days, 95% CI 0.55 to 2.79; 1 study, 68 participants; low-certainty evidence). The effect of amorphous hydrogel dressings compared with other types of dressings is uncertain for pain at the donor site and wound complications, including scarring and itching (very low-certainty evidence). No adverse events were reported in any of the groups. The study did not report health-related quality of life or wound infection. Octenidine-based hydrogel dressing versus octenidine-free hydrogel dressing The effect of octenidine-based hydrogel dressings versus octenidine-free hydrogel dressings is uncertain for time to wound healing (MD 0.40, 95% CI 0.28 to 0.52; 1 study, 41 participants) and wound infection, as the certainty of the evidence is very low. The certainty of the evidence is also very low for adverse events, with two participants in the intervention group and one participant in the comparison group reporting adverse events (risk ratio (RR) 0.58, 95% CI 0.06 to 5.89; 1 study, 41 participants). The study did not report donor site pain, health-related quality of life, or wound complications.
AUTHORS' CONCLUSIONS: There is insufficient evidence to determine the effect of hydrogel dressings on donor site wounds of split thickness skin grafts compared with other types of dressings. There is a need for adequately powered and well-designed RCTs, with adequate sample sizes, types of populations and subgroups, types of interventions, and outcomes, that compare hydrogel dressings with other treatment options in the treatment of donor site wounds of split-thickness skin grafts.
供皮区创面是导致发病率的主要原因之一。选择合适的敷料对创面愈合至关重要。目前有多种类型的敷料可供选择，包括水凝胶敷料。需要对现有证据进行综述，以指导临床决策，选择合适的敷料治疗中厚皮片供皮区创面。
评估水凝胶敷料对中厚皮片供皮区创面愈合的影响。
2022 年 7 月，我们检索了 Cochrane 伤口专题数据库、CENTRAL、MEDLINE、Embase 和 CINAHL EBSCO Plus。我们还检索了临床试验注册库，以获取正在进行和未发表的研究，并对相关纳入研究的参考文献列表以及综述、荟萃分析和卫生技术报告进行了扫描，以确定其他研究。研究语种、发表时间和研究地点均不受限制。
比较水凝胶敷料与其他类型敷料、局部治疗或不治疗、或不同类型水凝胶敷料治疗中厚皮片供皮区创面的随机对照试验（RCT），无论语言和发表状态如何。
两位综述作者独立进行数据提取、使用 Cochrane 偏倚风险工具（偏倚风险 1）评估风险和根据 GRADE 方法进行质量评估。
我们纳入了这项综述的两项研究（162 名参与者）。其中一项研究有三个组，101 名参与者（15 个月的研究时间）在儿童医院进行，比较了 Sorbact 形式的水凝胶敷料与 Algisite（藻酸盐敷料）、Cuticerin（一种光滑的醋酸纤维纱布，浸渍防水软膏）。另一项研究有两个组，61 名参与者（19 个月的研究时间）在三个外科部门进行，比较了含有奥替尼啶的水凝胶敷料与相同的非抗菌水凝胶敷料。我们没有发现比较水凝胶敷料与其他治疗方法（如局部药物，即直接涂抹在伤口上的乳膏、软膏或溶液）、不治疗或水凝胶敷料与其他治疗方法联合与其他治疗方法单独治疗的研究。这两项研究都存在很高的失访偏倚风险，第二项研究也存在选择偏倚风险不明确。无定形水凝胶敷料与其他类型敷料相比无定形水凝胶敷料可能会延迟创面愈合时间，与藻酸盐（MD 1.67 天，95%置信区间（CI）0.56 至 2.78；1 项研究，69 名参与者；低质量证据）或 Cuticerin 敷料（MD 1.67 天，95%CI 0.55 至 2.79；1 项研究，68 名参与者；低质量证据）相比。无定形水凝胶敷料与其他类型敷料相比，在供皮区疼痛和创面并发症（包括瘢痕和瘙痒）方面的效果不确定（非常低质量证据）。任何组均未报告不良事件。该研究未报告健康相关生活质量或伤口感染。奥替尼啶基水凝胶敷料与不含奥替尼啶的水凝胶敷料相比奥替尼啶基水凝胶敷料与不含奥替尼啶的水凝胶敷料在创面愈合时间（MD 0.40，95%CI 0.28 至 0.52；1 项研究，41 名参与者）和感染方面的效果不确定，因为证据的确定性非常低。不良事件的证据确定性也非常低，干预组中有两名参与者和对照组中有一名参与者报告了不良事件（RR 0.58，95%CI 0.06 至 5.89；1 项研究，41 名参与者）。该研究未报告供皮区疼痛、健康相关生活质量或创面并发症。
目前尚无足够的证据确定与其他类型敷料相比，水凝胶敷料对中厚皮片供皮区创面的影响。需要进行足够数量和设计良好的 RCT，纳入足够的样本量、人群和亚组类型、干预类型和结局，比较水凝胶敷料与其他治疗选择在治疗中厚皮片供皮区创面中的应用。
